頸椎管狹窄之病患於咽喉切除術後併發四肢麻痺－病例報告

Quadriplegia Following Laryngopharyngectomy in a Patient with Cervical Spinal Stenosis - Case Report

劉亞伯(Ya-Po Liu) ； 蔡森田(Sen-Tien Tsai)

《中華民國耳鼻喉科醫學雜誌》 36卷6期 (2001/10) Pp. 388-391

https://doi.org/10.6286/2001.36.6.388

摘要

喉部手術病患常需要採頸部過度伸展姿勢。然此種姿勢對年齡大、需接受長時間手術之病人有其潛在的危險性。本病例為70歲男性，因罹患下咽癌於本院接受全喉及部分咽切除、兩側頸部淋巴結廓清術及前臂游離皮瓣重建術。病人術前並無任何神經學徵兆，術後發現有四肢麻痺現象，核磁共振照影顯示第三到第五頸脊髓水腫，雖給予類固醇治療卻無進展。後因併發氣管造口附近咽皮瘻管，病人無法有效咳出滲出物而造成吸入性肺炎，雖予以積極治療，卻不幸因敗血症死亡。術後回顧影像學檢查，發現病人有頸椎管狹窄之情形，由於手術中長時間頸部被動過度伸展姿勢，造成頸椎壓迫而導致四肢麻痺。喉部手術時常有頸部被動過度伸展的姿勢，若不幸遇到脊椎管狹窄的病人，可能造成四肢麻痺的嚴重合併症，所以手術前對於脊椎管的影像評估是絕對必要的。

關鍵字

喉部手術 ； 頸椎骨刺 ； 脊椎管狹窄 ； 過度伸展 ； 四肢麻痺

並列摘要

Patients are usually put in a cervical hyperextension position during laryngeal surgery, but there are potential risks to older patients who undergo lengthy procedures. A 70-year-old man with hypopharyngeal cancer who underwent laryngopharyngectomy with bilateral neck dissection and anterior forearm free flap reconstruction is described. He had no neurological symptoms pre-operatively but was quadriplegic post-operatively. MRI showed C3-5 edematous myelopathy and the condition did not improve with steroid therapy. A pharyngo-cutaneous fistula subsequently developed near the permanent tracheostoma. Saliva draining into the trachea could not be coughed out effectively and an aspiration pneumonia developed. The patient expired from sepsis intensive treatment. Review of pre-operative CT scans identified cervical spine stenosis. It became apparent that the prolonged passive hyperextension had led to a compressive myelopathy. Accordingly, routine radiological evaluation of the cervical spine in such patients is indicated.

並列關鍵字

laryngeal surgery ； cervical spondylosis ； spinal stenosis ； hyperextension ； quadriplegia